Zalwango’s pregnancy progressed without any complications. And just like any other expectant mother, she was eager to see her child. However, this did not come to pass.
For two days, she lay in a hospital bed without anyone to help her give birth and her baby died in her womb, writes Carol Natukunda.
Zalwango is in pain. But it is not the pain that worries her. It is the fact that after this story is published, her ‘man’ might be arrested. She conceived at just 16 — way underage.
“Please auntie, just lie that I am 18 because my boyfriend has been supportive. I do not want to lose him,” she told this reporter. It is after I convince her that I would focus on her health and hide her face that she finally relents.
Zalwango was working as a housemaid when she conceived. The man responsible for the pregnancy was a farmer in the neighbourhood.
Her pregnancy went well, until two weeks ago when she felt a fever. By this time, she had already run away from her former employer to live with her boyfriend. When she developed fever, her ‘in-laws’ took her to Pearl View Medical Centre in Kiwanga, a village near Namanve, in Mukono district.
Zalwango arrived at the clinic at about 10:00am on September 29, 2013. “The nurse told me the fever was because of pregnancy and put me on drip. After that, she said I was fi ne. But another doctor told me that my fever was very high. The nurse insisted I would be fi ne and told me to go back home,” she says.
Two days later, she returned to the clinic with intense pain. On suspicion that she was about to give birth, the doctor allegedly injected her with medication to induce labour. But for two days, there was no one to help this young mother give birth.
“The nurse was only calling my mother-in-law to tell her that I did not want to push. However, she never told me to push. In fact, she kept dodging me.
On the first day, I felt that the baby was not making any movement. When I told her, she said I was a naive girl who did not know what to do,” Zalwango recalls.
On the third day, Zalwango’s situation was deteriorating. She was in unbearable pain, and could hardly walk or talk. The nurses panicked and referred her to Mukono Health Centre. “They did not have any vehicle to transport me, so my husband’s family had to look for a cab,” she says.
They arrived at the health centre on October 3 and Zalwango was rushed to the theatre. The doctors discovered that her baby had been dead for two days.
When Sunday Vision visited Zalwango, she was still in critical condition. She complained of too much pain in her lower abdomen. A long tube had also been inserted in her vagina to aid urine flow.
Dr. Geoffrey Kasirye, a senior doctor at Mukono Health Centre, says they will continue monitoring her. “We have put her on medication and we pray that the worst does not happen. If the urine starts leaking uncontrollably, it will mean that she has fistula,” Kasirye says.
He expresses disappointment that the previous clinic had not done much to save the girl from the pain and death of her baby. “This is a young mother. She was in a state we call maternal exhaustion. The baby’s heartbeat was not there and we moved fast to save the mother,” Kasirye says, adding that the baby had been a healthy girl weighing 3.6kg.
“Any serious doctor should have suspected this baby was too big for such a young mother to push because her pelvic muscles are still very small. We have seen teenage mothers give birth normally, but this is because their babies are small.
“For Zalwango, this was a uterine death. The baby’s skin had peeled off and it looked like it had been burnt. We estimate that the baby died two days before they brought her here,” he says.
Kasirye also questioned the professionalism of Pearl View Medical Centre, given that the referral letter did not have any details of the diagnosis.
Sunday Vision saw a copy of the letter signed by Benon Bossa. It claims that the girl was fi rst admitted at Pearl View on October 2, and not earlier, and states ‘labourlike pain’ as the history and symptoms. The diagnosis and reason for referral is stated as ‘labour pain’. It does not name the investigation done. However, it names treatment given as IV Pitocin 5% Dertnse.
The referral letter issued on October 3
To this, Dr. Kasirye says: “When you are referring a patient, you have to put in details. We do not know for how long she was in labour. For the drug they gave her, only a doctor should prescribe it because the uterus could rupture,” he says, adding that he is working with his supervisors to follow up on the said clinic and its legality.
AT THE CLINIC
Tucked away in Kiwanga village, Pearl View Medical Centre is by all standards a modern clinic. It is spacious with a big compound and few patients. In front of it is another building which looks like an annex of the main house. In the compound are chicken and pigeons feeding on mush.
On the day Sunday Vision visited, about four men who looked like potters were basking in the sun. Pretending to be looking for an internship placement, I asked to talk to Dr. Bossa. They directed me inside the paediatrics room.
There, I found a nurse immunising a baby and told her I was looking for Dr. Bossa. “He went upcountry,” she said. I convinced her to give me his telephone number.
As I later realised, it was the same number on the referral report. When contacted on phone, Dr. Bossa denied irresponsibility on his part.
“She is lying. She was attended to and we referred her within one day when we realised that we could not handle her situation. Our policy is to refer patients within 24 hours. The first time she came, it was over fever and it was treated. The second time she came, we had a midwife to attend to her, but we referred her right away,” he said.
IS BOSSA REGISTERED?
Questions abound as to whether Bossa is a trained medic. An annual practising licence register at the Uganda Medical and Dental Practitioners Association, which was last updated on October 11, 2013 does not have anyone called Dr. Benon Bossa.
TEENAGE PREGNANCY DILEMMA
In Uganda, one out of four teenagers aged between 15 and 18 years is either pregnant or has a child, according to the
2011 Uganda Demographic and Health Survey.
According to a statement from the United Nations Population Fund (UNFPA) on World Population Day, about 16 million girls
of 15-19 years give birth each year. The majority do not have access to contraception. This has resulted into unsafe abortions, unnecessary deaths, several complications that come with childbirth such as fistula and excessive bleeding.
UNFPA states that complications from pregnancy and child birth are the leading cause of death among girls in this age group, especially in developing countries. About 90% of the pregnant adolescents in the developing world are married.
Often, it is a consequence of coercion, desperate circumstances, discrimination, rights violations (including child
marriage) or inadequate education.
“Pregnancy jeopardises the rights, health, education and potential of far too many adolescent girls, robbing them of a better future,” the UNFPA executive director, Dr. Babatunde Osotimehin, said. In Uganda, one out of four teenagers aged between 15 and 18 years is either pregnant or has a child, according to the 2011 Uganda Demographic and Health Survey.
“The main problem is the age. Many have underdeveloped pelvic bones and cannot deliver normally,” says Josephine Namuleme, a midwife at Kasambya Health Centre III in Mubende. She says out of 70 deliveries which were done in May, almost half were young mothers below 20 years.